Safety of oral intake prior to cardiac catheterization with minimal to moderate sedation: A systematic review and meta-analysis of randomized controlled trials.

Fasting prior to percutaneous cardiac procedures is common, despite a lack of high-quality evidence. We conducted a systematic review and meta-analysis to assess the safety of a nonfasting strategy. Online databases Medline, Cochrane CENTRAL, and Google Scholar were searched. Quantitative analysis was performed using R software (Version 4.1.2) with meta package. Analyzed outcomes included nausea, vomiting, aspiration, intubation, hypoglycemia, hypotension, acute kidney injury, patient satisfaction score, and length of hospital stay. Eight randomized controlled trials were included with 3,382 patients. There was no significant difference between fasting and nonfasting for nausea/vomiting odds ratio (OR) 0.99 (95% CI, 0.68-1.45), hypoglycemia OR 1.28 (95% CI, 0.75-2.18), aspiration OR 0.72 (95% CI, 0.36-1.43), acute kidney injury OR 0.69 (95% CI, 0.38-1.23), and hypotension OR 1.57 (95% CI, 0.47-5.30). No patient in either group underwent endotracheal intubation. Additionally, there was no difference in patient satisfaction score and length of hospital stay with a standardized mean difference (SMD) of 0.23 (95% CI, -0.62 to 1.07) and 0.0 (95% CI, -0.6 to 0.7) respectively. Sub-group analysis, however, showed increased odds of nausea/vomiting in the fasting group compared to nonfasting OR 1.20 (95% CI, 1.04-1.39) and decreased odds of acute kidney injury in fasting compared to nonfasting group OR 0.50 (95% CI, 0.28-0.89). In conclusion, this analysis shows no significant difference in most safety outcomes between a fasting and a nonfasting strategy with potential increase in nausea/vomiting and decrease in acute kidney injury with fasting. More studies are needed to better understand these differences.